Provider Demographics
NPI:1538293014
Name:PERFORMANCE CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:PERFORMANCE CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-337-3636
Mailing Address - Street 1:1834 KELLER PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3761
Mailing Address - Country:US
Mailing Address - Phone:817-337-3636
Mailing Address - Fax:817-337-3635
Practice Address - Street 1:1834 KELLER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3761
Practice Address - Country:US
Practice Address - Phone:817-337-3636
Practice Address - Fax:817-337-3635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF006803111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV08295Medicare UPIN
TX8C9886Medicare ID - Type UnspecifiedDENNIS JAMES DC
TX8G3812Medicare ID - Type UnspecifiedLACY JAMES DC
TXV02823Medicare UPIN